TyG index predicts complex CAD in young adults with aortic valve calcification

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Frontiers in Medicine Published April 14, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider the TyG index for complex CAD risk stratification in young adults with aortic valve calcification.

This cross-sectional study included an analytic cohort of 260 patients aged 18 to 65 years with aortic valve calcification. The primary exposure was the triglyceride-glucose (TyG) index and the ACEF score, evaluated for their association with anatomically complex coronary artery disease (CAD), defined as a SYNTAX score of 23 or higher. The study also assessed the predictive performance of these metrics and compared acute myocardial infarction incidence between patients with and without aortic valve calcification.

In the analytic cohort, both the TyG index and ACEF score showed significant associations with complex CAD. However, a significant interaction was observed (p for interaction = 0.002), indicating that aortic valve calcification status modified these associations. Specifically, in patients with aortic valve calcification, the TyG index remained an independent predictor of complex CAD with an adjusted odds ratio of 3.82 (95% CI 1.69–8.63). Conversely, the ACEF score was no longer significantly associated with complex CAD in this subgroup.

In patients without aortic valve calcification, the ACEF score remained a strong predictor of complex CAD, while the TyG index did not demonstrate significant predictive value. Additionally, the incidence of acute myocardial infarction was lower in patients with aortic valve calcification (31.9%) compared to those without (46.5%). No safety data, adverse events, or tolerability information were reported in this cross-sectional analysis.

The study design is observational and cross-sectional, limiting the ability to infer causality between the metabolic indices and CAD complexity. The lack of reported safety data and the specific focus on a younger population with aortic valve calcification restrict the generalizability of these findings to broader clinical settings. These results support the potential integration of the TyG index into pathophysiology-informed risk stratification strategies for younger patients with CAD, particularly those with aortic valve calcification.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundAortic valve calcification (AVC) is an active pathophysiological process that shares metabolic risk factors with coronary artery disease (CAD). However, whether AVC modifies the associations between metabolic or physiological risk indices and coronary anatomical complexity remains uncertain, particularly in younger populations. This study aimed to determine if AVC alters the relationships of the triglyceride–glucose (TyG) index, a surrogate marker of insulin resistance, and the ACEF score, an indicator of physiological reserve, with anatomically complex CAD, and to compare their predictive performance in young and middle-aged adults.MethodsThis cross-sectional study enrolled 326 consecutive patients aged 18–65 years who underwent coronary angiography. For the primary analysis of coronary lesion complexity, 66 patients with prior revascularization history were excluded, yielding a final analytic cohort of 260 patients. Anatomically complex CAD was defined as a SYNTAX score ≥23. AVC status, determined by echocardiography, was evaluated as a potential modifier. Multivariable logistic regression models were used to assess the associations of the TyG index and ACEF score with complex CAD, followed by formal testing for interaction between each index and AVC status. When significant interactions were identified, stratified analyses were performed. The discriminatory performance was evaluated using receiver operating characteristic (ROC) curve analysis in the analytic cohort and within AVC-stratified subgroups, with formal comparison of area under the curve (AUC) values between subgroups.ResultsIn the analytic cohort, both TyG index and ACEF score showed significant association with anatomically complex CAD. Formal interaction testing demonstrated that AVC status significantly modified these associations (p for interaction = 0.002). In patients with AVC, the TyG index emerged as an independent predictor of complex CAD (adjusted OR 3.82, 95% CI 1.69–8.63; AUC = 0.714), whereas the ACEF score was no longer significantly associated with lesion complexity. Conversely, in patients without AVC, the ACEF score remained a strong predictor of complex CAD, while the TyG index showed no significant predictive value. Notably, despite exhibiting more anatomically severe CAD, patients with AVC had a lower incidence of acute myocardial infarction compared with those without AVC (31.9% vs. 46.5%).ConclusionAmong young and middle-aged adults, AVC identifies a distinct phenotype of metabolically driven, anatomically complex CAD. In this context, the TyG index provides superior and phenotype-specific predictive value, supporting its integration into pathophysiology-informed risk stratification strategies for younger patients with CAD.